Claims processing, including back-end services such as adjudication, decisioning, and reimbursement, requires the ingestion and processing of a diverse set of media and complex data types. These can include paper or digital media, images, video, text, and structured and unstructured information. Additionally, each claim form type may have its own associated processing rules.
The customer’s existing approach involved using standard optical character recognition (OCR) with rules-based processing, and led to both large and unwieldy rulesets and a very lengthy exceptions queue. In order to handle the data and deal with the growing list of exception cases, the company relied on manual intervention done by human knowledge workers to make up for their system’s shortcomings.
Manual claims processing is often inefficient and prone to costly and time-consuming errors, especially when complex data is being processed. Reliance on this kind of processing can also stymie growth and make upscaling in times of increased demand more difficult and expensive.